Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke
Background and AimsCryptogenic stroke (CS) is associated with a high rate of recurrences and adverse outcomes at long-term follow-up, especially due to its unknown etiology that often leads to ineffective secondary prevention. Asymptomatic atrial fibrillation (AF) could play an important pathophysio...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-04-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.869076/full |
| _version_ | 1818047068716924928 |
|---|---|
| author | Gabriella Bufano Francesco Radico Carolina D'Angelo Francesca Pierfelice Maria Vittoria De Angelis Massimiliano Faustino Sante Donato Pierdomenico Sabina Gallina Giulia Renda |
| author_facet | Gabriella Bufano Francesco Radico Carolina D'Angelo Francesca Pierfelice Maria Vittoria De Angelis Massimiliano Faustino Sante Donato Pierdomenico Sabina Gallina Giulia Renda |
| author_sort | Gabriella Bufano |
| collection | DOAJ |
| description | Background and AimsCryptogenic stroke (CS) is associated with a high rate of recurrences and adverse outcomes at long-term follow-up, especially due to its unknown etiology that often leads to ineffective secondary prevention. Asymptomatic atrial fibrillation (AF) could play an important pathophysiological role. Some studies have pointed to left atrial (LA) and left ventricular (LV) systolic and diastolic dysfunction as surrogate markers of AF. The aim of the study is to evaluate the relationship between echocardiographic parameters of LA and LV function, and the occurrence of AF revealed by continuous ECG monitoring in a cohort of patients with CS.MethodsSingle-center prospective cohort study. Seventy-two patients with CS with insertable cardiac monitors (ICM) underwent transthoracic echocardiography (TTE). TTE was focused on LA and LV function, including both standard and longitudinal strain-derived parameters. All detected AF episodes lasting more than 2 min were considered.ResultsContinuous ECG monitoring revealed subclinical AF in 23 patients (32%) at an average of 6.5 months after ICM implantation. Many echocardiographic parameters, indicating LA volume and LV systolic/diastolic function, were significantly associated with the occurrence of AF, suggesting the worst atrial function in the AF group. Furthermore, multivariable regression analysis revealed that peak atrial contraction strain and left ventricular strain were independently associated with AF (adjusted OR = 0.72, CI 95% 0.48–0.90, p = 0.005, and adjusted OR = 0.69, CI 95% 0.46–0.95, p = 0.041, respectively).ConclusionIn patients with CS, LA and LV strain analysis add predictive value for the occurrence of AF over clinical and morpho-functional echocardiographic parameters. Impaired booster pump strain and LV longitudinal strain are strong and independent predictors of AF. |
| first_indexed | 2024-12-10T09:59:55Z |
| format | Article |
| id | doaj.art-66ec8c3b640f4dbd9df527baed7ee748 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-10T09:59:55Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-66ec8c3b640f4dbd9df527baed7ee7482022-12-22T01:53:22ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-04-01910.3389/fcvm.2022.869076869076Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic StrokeGabriella Bufano0Francesco Radico1Carolina D'Angelo2Francesca Pierfelice3Maria Vittoria De Angelis4Massimiliano Faustino5Sante Donato Pierdomenico6Sabina Gallina7Giulia Renda8Department of Innovative Technologies in Medicine & Dentistry, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, ItalyDepartment of Cardiology, Renzetti Hospital, Lanciano, ItalyDepartment of Cardiology, Renzetti Hospital, Lanciano, ItalyDepartment of Innovative Technologies in Medicine & Dentistry, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, ItalyDepartment of Neurology, Stroke Unit, SS Annunziata Hospital, Chieti, ItalyDepartment of Cardiology, SS Annunziata Hospital, Chieti, ItalyDepartment of Innovative Technologies in Medicine & Dentistry, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, ItalyBackground and AimsCryptogenic stroke (CS) is associated with a high rate of recurrences and adverse outcomes at long-term follow-up, especially due to its unknown etiology that often leads to ineffective secondary prevention. Asymptomatic atrial fibrillation (AF) could play an important pathophysiological role. Some studies have pointed to left atrial (LA) and left ventricular (LV) systolic and diastolic dysfunction as surrogate markers of AF. The aim of the study is to evaluate the relationship between echocardiographic parameters of LA and LV function, and the occurrence of AF revealed by continuous ECG monitoring in a cohort of patients with CS.MethodsSingle-center prospective cohort study. Seventy-two patients with CS with insertable cardiac monitors (ICM) underwent transthoracic echocardiography (TTE). TTE was focused on LA and LV function, including both standard and longitudinal strain-derived parameters. All detected AF episodes lasting more than 2 min were considered.ResultsContinuous ECG monitoring revealed subclinical AF in 23 patients (32%) at an average of 6.5 months after ICM implantation. Many echocardiographic parameters, indicating LA volume and LV systolic/diastolic function, were significantly associated with the occurrence of AF, suggesting the worst atrial function in the AF group. Furthermore, multivariable regression analysis revealed that peak atrial contraction strain and left ventricular strain were independently associated with AF (adjusted OR = 0.72, CI 95% 0.48–0.90, p = 0.005, and adjusted OR = 0.69, CI 95% 0.46–0.95, p = 0.041, respectively).ConclusionIn patients with CS, LA and LV strain analysis add predictive value for the occurrence of AF over clinical and morpho-functional echocardiographic parameters. Impaired booster pump strain and LV longitudinal strain are strong and independent predictors of AF.https://www.frontiersin.org/articles/10.3389/fcvm.2022.869076/fullatrial fibrillationcryptogenic strokeinsertable cardiac monitoratrial myopathyleft atrial strainleft ventricular longitudinal strain |
| spellingShingle | Gabriella Bufano Francesco Radico Carolina D'Angelo Francesca Pierfelice Maria Vittoria De Angelis Massimiliano Faustino Sante Donato Pierdomenico Sabina Gallina Giulia Renda Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke Frontiers in Cardiovascular Medicine atrial fibrillation cryptogenic stroke insertable cardiac monitor atrial myopathy left atrial strain left ventricular longitudinal strain |
| title | Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke |
| title_full | Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke |
| title_fullStr | Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke |
| title_full_unstemmed | Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke |
| title_short | Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke |
| title_sort | predictive value of left atrial and ventricular strain for the detection of atrial fibrillation in patients with cryptogenic stroke |
| topic | atrial fibrillation cryptogenic stroke insertable cardiac monitor atrial myopathy left atrial strain left ventricular longitudinal strain |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.869076/full |
| work_keys_str_mv | AT gabriellabufano predictivevalueofleftatrialandventricularstrainforthedetectionofatrialfibrillationinpatientswithcryptogenicstroke AT francescoradico predictivevalueofleftatrialandventricularstrainforthedetectionofatrialfibrillationinpatientswithcryptogenicstroke AT carolinadangelo predictivevalueofleftatrialandventricularstrainforthedetectionofatrialfibrillationinpatientswithcryptogenicstroke AT francescapierfelice predictivevalueofleftatrialandventricularstrainforthedetectionofatrialfibrillationinpatientswithcryptogenicstroke AT mariavittoriadeangelis predictivevalueofleftatrialandventricularstrainforthedetectionofatrialfibrillationinpatientswithcryptogenicstroke AT massimilianofaustino predictivevalueofleftatrialandventricularstrainforthedetectionofatrialfibrillationinpatientswithcryptogenicstroke AT santedonatopierdomenico predictivevalueofleftatrialandventricularstrainforthedetectionofatrialfibrillationinpatientswithcryptogenicstroke AT sabinagallina predictivevalueofleftatrialandventricularstrainforthedetectionofatrialfibrillationinpatientswithcryptogenicstroke AT giuliarenda predictivevalueofleftatrialandventricularstrainforthedetectionofatrialfibrillationinpatientswithcryptogenicstroke |